{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T17:15:41Z","timestamp":1788887741464,"version":"build-2803163510"},"reference-count":44,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T00:00:00Z","timestamp":1708387200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>The effect of different diet patterns on psoriasis (PSO) and psoriatic arthritis (PSA) is unknown. \u03a4he aim of our study was to evaluate the effectiveness of a Mediterranean diet (MD) and Ketogenic diet (KD), in patients with PSO and PSA. Twenty-six patients were randomly assigned to start either with MD or KD for a period of 8 weeks. After a 6-week washout interval, the two groups were crossed over to the other type of diet for 8 weeks. At the end of this study, MD and KD resulted in significant reduction in weight (p = 0.002, p &lt; 0.001, respectively), in BMI (p = 0.006, p &lt; 0.001, respectively), in waist circumference (WC) (p = 0.001, p &lt; 0.001, respectively), in total fat mass (p = 0.007, p &lt; 0.001, respectively), and in visceral fat (p = 0.01, p &lt; 0.001, respectively), in comparison with baseline. After KD, patients displayed a significant reduction in the Psoriasis Area and Severity Index (PASI) (p = 0.04), Disease Activity Index of Psoriatic Arthritis (DAPSA) (p = 0.004), interleukin (IL)-6 (p = 0.047), IL-17 (p = 0.042), and IL-23 (p = 0.037), whereas no significant differences were observed in these markers after MD (p &gt; 0.05), compared to baseline. The 22-week MD\u2013KD diet program in patients with PSO and PSA led to beneficial results in markers of inflammation and disease activity, which were mainly attributed to KD.<\/jats:p>","DOI":"10.3390\/ijms25052475","type":"journal-article","created":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T07:50:26Z","timestamp":1708415426000},"page":"2475","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":42,"title":["The Effect of a Ketogenic Diet versus Mediterranean Diet on Clinical and Biochemical Markers of Inflammation in Patients with Obesity and Psoriatic Arthritis: A Randomized Crossover Trial"],"prefix":"10.3390","volume":"25","author":[{"given":"Vaia","family":"Lambadiari","sequence":"first","affiliation":[{"name":"Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pelagia","family":"Katsimbri","sequence":"additional","affiliation":[{"name":"Rheumatology and Clinical Immunology Unit, Fourth Department of Internal Medicine, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aikaterini","family":"Kountouri","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanouil","family":"Korakas","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Argyro","family":"Papathanasi","sequence":"additional","affiliation":[{"name":"Second Department of Dermatology and Venereology, University of Athens Medical School, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eirini","family":"Maratou","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Pavlidis","sequence":"additional","affiliation":[{"name":"Second Cardiology Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loukia","family":"Pliouta","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8241-7886","authenticated-orcid":false,"given":"Ignatios","family":"Ikonomidis","sequence":"additional","affiliation":[{"name":"Second Cardiology Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Malisova","sequence":"additional","affiliation":[{"name":"Independent Researcher, 11142 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dionysios","family":"Vlachos","sequence":"additional","affiliation":[{"name":"Independent Researcher, 16451 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evangelia","family":"Papadavid","sequence":"additional","affiliation":[{"name":"Second Department of Dermatology and Venereology, University of Athens Medical School, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"m1590","DOI":"10.1136\/bmj.m1590","article-title":"National, regional, and worldwide epidemiology of psoriasis: Systematic analysis and modelling study","volume":"369","author":"Parisi","year":"2020","journal-title":"BMJ"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1007\/s12016-016-8535-x","article-title":"The inflammatory response in psoriasis: A comprehensive review","volume":"50","author":"Deng","year":"2016","journal-title":"Clin. Rev. Allergy Immunol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1111\/j.1600-0625.2007.00629.x","article-title":"Immunopathogenesis of psoriasis","volume":"16","author":"Sabat","year":"2007","journal-title":"Exp. Dermatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"32","DOI":"10.5314\/wjd.v2.i4.32","article-title":"Metabolic co-morbidities and psoriasis: The chicken or the egg?","volume":"2","author":"Dalamaga","year":"2013","journal-title":"World J. Dermatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1159\/000433528","article-title":"Prevalence of Obesity in Patients with Psoriasis: Results of the National Study PsoHealth3","volume":"231","author":"Jacobi","year":"2015","journal-title":"Dermatology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2484","DOI":"10.1016\/j.jid.2017.07.822","article-title":"Obesity, Waist Circumference, Weight Change, and Risk of Incident Psoriasis: Prospective Data from the HUNT Study","volume":"137","author":"Snekvik","year":"2017","journal-title":"J. Investig. Dermatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.1001\/archinte.167.15.1670","article-title":"Obesity, Waist Circumference, Weight Change, and the Risk of Psoriasis in Women: Nurses\u2019 Health Study II","volume":"167","author":"Setty","year":"2007","journal-title":"Arch. Intern. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1007\/s10654-018-0366-z","article-title":"Body mass index, abdominal fatness, weight gain and the risk of psoriasis: A systematic review and dose-response meta-analysis of prospective studies","volume":"33","author":"Aune","year":"2018","journal-title":"Eur. J. Epidemiol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Armstrong, A.W., Harskamp, C.T., and Armstrong, E.J. (2012). The association between psoriasis and obesity: A systematic review and meta-analysis of observational studies. Nutr. Diabetes, 2.","DOI":"10.1038\/nutd.2012.26"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1159\/000156599","article-title":"Impact of body mass index and obesity on clinical response to systemic treatment for psoriasis. Evidence from the Psocare project","volume":"217","author":"Naldi","year":"2008","journal-title":"Dermatology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2191","DOI":"10.1093\/rheumatology\/kew326","article-title":"The influence of obesity on response to tumour necrosis factor-inhibitors in psoriatic arthritis: Results from the DANBIO and ICEBIO registries","volume":"55","author":"Glintborg","year":"2016","journal-title":"Rheumatology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1111\/j.1529-8019.2009.01281.x","article-title":"Correlation between BMI and PASI in patients affected by moderate to severe psoriasis undergoing biological therapy","volume":"23","author":"Bardazzi","year":"2010","journal-title":"Dermatol. Ther."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Singh, S., Facciorusso, A., Singh, A.G., Vande Casteele, N., Zarrinpar, A., Prokop, L.J., Grunvald, E.L., Curtis, J.R., and Sandborn, W.J. (2018). Obesity and response to anti-tumor necrosis factor-[alpha] agents in patients with select immune-mediated inflammatory diseases: A systematic review and meta-analysis. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0195123"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"404","DOI":"10.3109\/09546634.2011.593489","article-title":"Impact of body mass index on retention rates of anti-TNF-alfa drugs in daily practice for psoriasis","volume":"23","author":"Tasin","year":"2012","journal-title":"J. Dermatolog. Treat."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1172\/JCI29881","article-title":"Obesity induces a phenotypics witch in adipose tissue macrophage polarization","volume":"117","author":"Lumeng","year":"2007","journal-title":"J. Clin. Investig."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.18632\/oncotarget.22260","article-title":"Serum levels of adipokines and cytokines in psoriasis patients: A systematic review and meta-analysis","volume":"9","author":"Bai","year":"2017","journal-title":"Oncotarget"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Alotaibi, H.A. (2018). Effects of Weight Loss on Psoriasis: A Review of Clinical Trials. Cureus, 10.","DOI":"10.7759\/cureus.3491"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"259","DOI":"10.3945\/ajcn.115.125849","article-title":"Long-term effects of weight reduction on the severity of psoriasis in a cohort derived from a randomized trial: A prospective observational follow-up study","volume":"104","author":"Jensen","year":"2016","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s13679-020-00380-3","article-title":"Deciphering the Association Between Psoriasis and Obesity: Current Evidence and Treatment Considerations","volume":"9","author":"Paroutoglou","year":"2020","journal-title":"Curr. Obes. Rep."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1038\/ijo.2015.64","article-title":"Effect of lifestyle weight loss intervention on disease severity in patients with psoriasis: A systematic review and meta-analysis","volume":"39","author":"Upala","year":"2015","journal-title":"Int. J. Obes."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"151","DOI":"10.2147\/PTT.S328581","article-title":"Dietary Intervention and Supplements in the Management of Psoriasis: Current Perspectives","volume":"12","author":"Chung","year":"2022","journal-title":"Psoriasis Targets Ther."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2274","DOI":"10.1017\/S1368980011002515","article-title":"Mediterranean diet pyramid today. Science and cultural updates","volume":"14","author":"Berry","year":"2011","journal-title":"Public Health Nutr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1097\/MCO.0000000000000872","article-title":"The anti-inflammatory effects of a Mediterranean diet: A review","volume":"25","author":"Itsiopoulos","year":"2022","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s11154-019-09514-y","article-title":"Efficacy and safety of very low calorie ketogenic diet (VLCKD) in patients with overweight and obesity: A systematic review and meta-analysis","volume":"21","author":"Castellana","year":"2020","journal-title":"Rev. Endocr. Metab. Disord."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1016\/j.nut.2012.01.016","article-title":"Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2 diabetes","volume":"28","author":"Hussain","year":"2012","journal-title":"Nutrition"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"105828","DOI":"10.1155\/2015\/105828","article-title":"Inflammation and Oxidative Stress: The Molecular Connectivity between Insulin Resistance, Obesity, and Alzheimer\u2019s Disease","volume":"2015","author":"Verdile","year":"2015","journal-title":"Mediat. Inflamm."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e95","DOI":"10.1111\/epi.13038","article-title":"Ketogenic diet exhibits anti-inflammatory properties","volume":"56","author":"Dupuis","year":"2015","journal-title":"Epilepsia"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1016\/j.jid.2019.07.718","article-title":"The Influence of Ketogenic Diets on Psoriasiform-like Skin Inflammation","volume":"140","author":"Sternberg","year":"2019","journal-title":"J. Investig. Dermatol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1016\/j.orcp.2015.10.008","article-title":"Very low-calorie ketogenic diet may allow restoring response to systemic therapy in relapsing plaque psoriasis","volume":"10","author":"Castaldo","year":"2015","journal-title":"Obes. Res. Clin. Pract."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1509","DOI":"10.1021\/acs.jproteome.0c00646","article-title":"Effect of Very-Low-Calorie Ketogenic Diet on Psoriasis Patients: A Nuclear Magnetic Resonance-Based Metabolomic Study","volume":"20","author":"Castaldo","year":"2020","journal-title":"J. Proteome Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"110757","DOI":"10.1016\/j.nut.2020.110757","article-title":"Aggressive weight-loss program with a ketogenic induction phase for the treatment of chronic plaque psoriasis: A proof-of-concept, single-arm, open-label clinical trial","volume":"74","author":"Castaldo","year":"2020","journal-title":"Nutrition"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Pinto, A., Bonucci, A., Maggi, E., Corsi, M., and Businaro, R. (2018). Anti-Oxidant and Anti-Inflammatory Activity of Ketogenic Diet: New Perspectives for Neuroprotection in Alzheimer\u2019s Disease. Antioxidants, 7.","DOI":"10.3390\/antiox7050063"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"9292","DOI":"10.1074\/jbc.M109.093955","article-title":"Deficiency in the nuclear factor E2-related factor-2 transcription factor results in impaired adipogenesis and protects against diet-induced obesity","volume":"285","author":"Pi","year":"2010","journal-title":"J. Biol. Chem."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1038\/nm.3804","article-title":"The ketone metabolite \u03b2-hydroxybutyrate blocks NLRP3 inflammasome-mediated inflammatory disease","volume":"21","author":"Youm","year":"2015","journal-title":"Nat. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1089\/ars.2007.1672","article-title":"NAD+\/NADH and NADP+\/NADPH in cellular functions and cell death: Regulation and biological consequences","volume":"10","author":"Ying","year":"2008","journal-title":"Antioxid. Redox Signal."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1136\/ard.62.3.208","article-title":"An experimental study of a Mediterranean diet intervention for patients with rheumatoid arthritis","volume":"62","author":"Hagfors","year":"2003","journal-title":"Ann. Rheum. Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1093\/ajcn\/nqaa019","article-title":"Anti-inflammatory Diet in Rheumatoid Arthritis (ADIRA)\u2014A randomized, controlled crossover trial indicating effects on disease activity","volume":"111","author":"Vadell","year":"2020","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"12810","DOI":"10.1111\/dth.12810","article-title":"Adherence to Mediterranean diet in Spanish patients with psoriasis: Cardiovascular benefits?","volume":"32","year":"2019","journal-title":"Dermatol. Ther."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s12967-014-0372-1","article-title":"Nutrition and psoriasis: Is there any association between the severity of the disease and adherence to the Mediterranean diet?","volume":"13","author":"Barrea","year":"2015","journal-title":"J. Transl. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1001\/jamadermatol.2018.2127","article-title":"Association between Mediterranean Anti-inflammatory Dietary Profile and Severity of Psoriasis: Results from the NutriNet-Sant\u00e9 Cohort","volume":"154","author":"Phan","year":"2018","journal-title":"JAMA Dermatol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1001\/jamadermatol.2018.1412","article-title":"Dietary Recommendations for Adults with Psoriasis or Psoriatic Arthritis from the Medical Board of the National Psoriasis Foundation: A Systematic Review","volume":"154","author":"Ford","year":"2018","journal-title":"JAMA Dermatol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1272","DOI":"10.1017\/S0007114513000482","article-title":"Extra-virgin olive oil consumption reduces the age-related decrease in HDL and paraoxonase 1 anti-inflammatory activities","volume":"110","author":"Loued","year":"2013","journal-title":"Br. J. Nutr."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Rochette-Egly, C., and Germain, P. (2009). Dynamic and combinatorial control of gene expression by nuclear retinoic acid receptors (RARs). Nucl. Recept. Signal., 7.","DOI":"10.1621\/nrs.07005"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1136\/annrheumdis-2015-207507","article-title":"Disease activity in psoriatic arthritis (PsA): Defining remission and treatment success using the DAPSA score","volume":"75","author":"Schoels","year":"2016","journal-title":"Ann. Rheum. Dis."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/25\/5\/2475\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:02:54Z","timestamp":1760104974000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/25\/5\/2475"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,20]]},"references-count":44,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,3]]}},"alternative-id":["ijms25052475"],"URL":"https:\/\/doi.org\/10.3390\/ijms25052475","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,20]]}}}